Leaders must take a hard line against powerful commercial interests and rethink global economic incentives within the food system in order to tackle the joint pandemics of obesity, undernutrition, and climate change, according to a report released by the Lancet Commission on Obesity.

A key recommendation from the Lancet Commission is the call to establish a new global treaty on food systems to limit the political influence of transnational food and beverage firms that undermine health for people and planet.

Led by the University of Auckland (New Zealand), George Washington University (U.S.), and the World Obesity Federation (U.K.), the new Lancet Commission is the result of a three-year project led by 43 commissioners and fellows with diverse expertise from 14 countries.

Over the past two decades, obesity, undernutrition, and climate change have become global pandemics that have common social and economic drivers, which the commission calls the global syndemic. The four major systems driving the global syndemic are food, transportation, land use, and urban design. These challenges have been addressed separately due to policymakers’ reluctance to implement effective strategies, opposition by vested commercial interests, and insufficient public demand for change.

However, undernutrition is declining too slowly to meet global targets, no country has reversed its obesity epidemic, and comprehensive policy responses to the threat of climate change has barely begun. Globally, malnutrition and obesity are by far the biggest causes of poor health, premature sickness, and death. Affecting 2 billion people worldwide, they are expected to worsen with climate change.

“Undernutrition and obesity are both driven by the same unhealthy, inequitable food systems, underpinned by a focus on economic growth while ignoring the negative health and equity outcomes,” said commission co-chair Boyd Swinburn. “Pursuit of short-term profits by governments and businesses have enabled them to ignore the environmental damage to food and agricultural systems. Using a systems thinking approach to address the common drivers of the global syndemic allows us to consider shared solutions to address decades of policy inertia.”

“Obesity, undernutrition, and climate change are all serious and complex problems,” said Vivica Kraak, associate professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech, who was involved in the commission’s efforts. “There many strategies and tools that governments and civil society can use to engage businesses and communities to ensure accountability for actions that impact the health of people and the planet. To address the global problem, we need social movements to make the status quo unappealing. We need to build social movements that promote actions that address malnutrition in all its forms, encourage flexitarian diets that promote sustainability, protect peoples’ right to healthy environments, and champion climate justice actions to address undernutrition, obesity, and climate change holistically.”

The commission offers examples of “triple duty” actions to address the global problem. First, national governments should adopt sustainable dietary guidelines to support health for people and the planet. This action aligns with the 2019 EAT-Lancet Commission report that calls for the transformation of food systems to promote healthy and sustainable flexitarian diets. Achieving this will involve people in high- and middle-income countries eating less red meat and adopting a plant-based diet rich in non-meat protein sources, whole grains, and fruits and vegetables.

Second, national governments should use incentives to make it easier for people to live without cars and encourage affordable and active transportation to increase physical activity, provide low-income people with transportation options to buy healthy foods, and to lower greenhouse gas emissions produced by automobiles. This action aligns closely with the 2018 Lancet Commission Countdown report on health and climate change.

Last year, the United Nations Intergovernmental Panel on Climate Change cautioned that governments have 12 years to implement changes by 2030 to energy, infrastructure, and industry systems to avoid the two-degree Celsius increase in the earth’s temperature that will drive global warming. In 2015, the leaders of 195 countries endorsed a commitment to lower greenhouse gas emissions at the Paris Agreement on Climate Change.

The commission also called for national governments and the United Nations system bodies, including the World Health Organization, to establish and adopt a Framework Convention on Food Systems to reduce the influence of the food, beverage, and agricultural industries on government policymaking that perpetuate unhealthy and unsustainable environments. Governments also need to incentivize businesses and mobilize communities to implement actions that support healthy, resilient, equitable, and sustainable food systems. Finally, a global philanthropic fund should be established to help communities and civil society advocate for effective changes.